Scientists Develop New Treatment Strategies For Child PsychopathsNPR's Audie Cornish speaks with writer Barbara Bradley Hagerty about her piece in The Atlantic on the children who are psychopaths, new treatment strategies and the brain science driving it.

NPR's Audie Cornish speaks with writer Barbara Bradley Hagerty about her piece in The Atlantic on the children who are psychopaths, new treatment strategies and the brain science driving it.

AUDIE CORNISH, HOST:

Between books and movies, you probably have a general idea of what a criminal psychopath looks like.

BARBARA BRADLEY HAGERTY: Psychopaths tend to be people who show no remorse, no empathy. They're very manipulative. Often they're very charming.

CORNISH: But what does that look like in a child? Barbara Bradley Hagerty has written about this for The Atlantic. And we spoke to her about how these kids' brains might be different.

HAGERTY: We know a lot more about adults, but psychologists do believe that kids are very similar in their brains. So what they know is there are kind of two neural quirks. One of them is that the limbic system or the emotional part of the brain doesn't seem to work as well, in particular the amygdala, the part of the brain that recognizes, for example, fear. The amygdala is smaller and less functional. What that means is that these kids do not recognize the cues that say, stop, don't attack me, OK?

In fact, I was talking to one psychologist who was interviewing an adult psychopath. And she showed him a picture of a woman who looked very fearful. And she said, what is that emotion? And he said, I don't know what you call that emotion, but this is just what people look like right before you stab them. Now, why does that matter? That matters because fear is a white flag. It tells you, don't attack me. I'm submissive.

The other really interesting neural quirk is that their reward system is kind of on overdrive. The brakes don't work. And so when they want to - want something, if they want that toy that that other toddler has or if they want to steal that car and throw the person out, they won't stop. Those two things are a very dangerous combination.

CORNISH: So in terms of how that plays out in children, your opening example is a young girl who's called Samantha for the sake of this story. How did she behave with her family?

HAGERTY: Very early on they began to see kind of aberrant behavior.

CORNISH: We're talking toddler age.

HAGERTY: We're talking toddler age, right. Exactly. Early on she would do things like she'd hit her siblings and would smile when they cried. Or she would rip up the money in her sister's piggy bank or destroy kind of other people's possessions. One of the really big red flags for the parents, Jan and Danny, was one day, when Samantha was 6 years old, Jen was driving Samantha and her siblings. And suddenly Jen heard this screaming. And she looked in the rearview mirror, and what she could see was Samantha had her hands around her little sister's neck. Her sister was trapped in the car seat. She managed to separate them.

Jen got Samantha home and said, you know, what were you doing? And she said, well, I was trying to choke her. Well, why? She wouldn't have been able to breathe. You could have killed her. Yes, I know that. What about the rest of us? Well, I want to kill all of you. She was 6 years old. She was already planning how to kill her family and other people. It was just hair-raising. So she ended up going to treatment.

CORNISH: Now, I want to talk more about the treatment because some people might hear this kind of diagnosis and think bad seed - right? - that's, like, the stuff of horror films, and that nothing can be done about it. But there is a small movement of people who believe that there is a kind of treatment. And you spent time in a Wisconsin juvenile facility that focused on kids that fall into this category. And they used a combination of counseling but then also quick and limited punishment and rewards. So I want to break that down. First, why limited punishment?

HAGERTY: Because these kids with callous, unemotional traits, they don't respond to punishment. You see this actually really on toddlers. You give them time out, these kids couldn't care less about time out. They just come out and they misbehave again. But what really does work is reward. So what they do at Mendota Juvenile Treatment Center, which is in Madison, Wis., is they really emphasize rewards.

So when they are good they will earn things like Pokemon cards or pizza on Saturday, or they can stay up late, or they get Internet radio. And what they find is these kids really respond to the rewards. And what they're trying to do is recognize that these kids may never feel morality. They may never feel empathy. But they might develop cognitive morality. They might develop cognitive empathy. And that's what they're trying to do.

CORNISH: When you think about a juvenile facility, often a kid has gone through a lot of punishments, right? They have been touched by the system. They've been through the court system. It sounds a little crazy to think that a kid - right? - who has been arrested, who has maybe been institutionalized already is suddenly going to be pacified by gum and Pokemon cards.

HAGERTY: (Laughter) I know, it does sound a little bit crazy. The thing is what they realized is that punishment isn't working, so why don't we try something else? And let's work with what works in the brain. And so what they have found is that there are early signs that this is actually working. And what they're doing is they're really trying to appeal to their self-interest, so just stay within the law and your life will be better. And this, they believe, is kind of creating this self-interested cognitive morality.

CORNISH: Cognitive morality. So it doesn't sound like you're saying these kids or young psychopaths actually feel morality, right? They're not actually gaining that emotion. They're just learning how to emulate it.

HAGERTY: Yeah, so I think that's basically what's going on. And what we have to understand is that this is all on a scale. Even the youth psychopathy checklist is a scale of 0 to 40, and anyone over 30 is kind of - you're worried about. But, you know, some people can develop a little bit of cognitive empathy. For example, I interviewed a person who's now 37 whom I named Carl. He was just a horror story. He would do things like kill his sister's hamster or swing the family cat around by the tail and let it go and thwap (ph) hit the wall. He was just a very scary guy. And by the time he got to Mendota when he was 15, he scored 38 on a scale of 40.

Well, he created bonds. He kind of developed some cognitive empathy, cognitive morality. Now he's married. It's his third marriage, but he's married. He has a couple of kids. He started his own funeral business. He's not really been in trouble with the law in the last more than 10 years. And so there is some evidence that he has developed this actual feeling of empathy for his clients. So I think there is hope.

CORNISH: The flipside is he went into the funeral business.

(LAUGHTER)

HAGERTY: Yes.

CORNISH: And also, even the day you go to interview him he's in the middle of earning misdemeanor charges for attacking his wife. And honestly, I have to say I was a little disturbed that the bar of success is they haven't killed anyone.

HAGERTY: Actually, when you talk to the psychologists at Mendota they say, hey, we're not looking for Mother Teresa. We're just happy if they're not committing armed robbery and killing people. I mean, this is the bar. And the reason is that - I mean, Carl's case actually shows how complicated it is. Here's a guy who is honestly trying every single day to stay within the law, but it is really, really hard for him to live a normal life even though he's trying.

CORNISH: What do we know about these kids and whether or not they are the product of abusive environments or whether there is some mystery gene that is yet to be discovered?

HAGERTY: Right. And that's a big question. So a lot of kids develop these traits out of almost a defense mechanism. And these tend to be the kids who are poor, who might live in abusive homes, who may be out on the street a lot. They have to develop a certain callousness and a certain lack of emotionality just to survive. It's believed by some that if you can put them in a safe environment that they actually will do very well and they will not end up as psychopaths. That is the thinking.

The scarier set of kids are those who have grown up in good, loving homes and yet it seems that they're deeply wired to be this way. Those are kids like Samantha. Even though Samantha was adopted, she went into a good foster home at 6 months and was adopted at 2 years and had no abuse in her family whatsoever. And so Samantha's someone who's had this great family life, and yet there's something very different about the way her brain works. That's nature. And that's scarier. And it's harder to treat.

CORNISH: Barbara Bradley Hagerty wrote the article "When Your Child Is A Psychopath" for The Atlantic. Thank you so much.

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